- Oral presentation
- Open Access
The role of cardiovascular magnetic resonance in women with suspected CAD: a CE-MARC substudy
© Greenwood et al; licensee BioMed Central Ltd. 2012
- Published: 1 February 2012
- Cardiovascular Magnetic Resonance
- Positive Predictive Value
- Negative Predictive Value
- Late Gadolinium Enhancement
- Significant Coronary Artery Disease
The CE-MARC study is the largest, prospective evaluation of cardiovascular magnetic resonance (CMR) in patients with suspected coronary artery disease (CAD). This predefined CE-MARC substudy compared the diagnostic performance of CMR and single-photon emission computed tomography (SPECT) in the female cohort.
Coronary artery disease (CAD) is the leading cause of death in women but despite this they are often underrepresented in non-invasive imaging studies. Furthermore, the use of myocardial perfusion imaging in women presents challenges not encountered in men including a low premenopausal prevalence of CAD, more atypical symptoms, a different pattern of disease (more frequent single-vessel disease and intermediate grade stenosis), breast attenuation artefacts and smaller heart size. This substudy aimed to compare the diagnostic performance of CMR and single-photon emission computed tomography (SPECT) in the female cohort of the CE-MARC study .
CE-MARC was a prospective study of 752 patients with suspected CAD. All patients were scheduled to undergo CMR and SPECT followed by invasive coronary angiography (the reference standard). CMR comprised adenosine stress/rest perfusion, cine imaging, late gadolinium enhancement and MR coronary angiography. Gated adenosine stress/rest SPECT was performed using 99mTc tetrofosmin. Visual analysis was performed on a per patient basis. For this pre-defined substudy, the diagnostic accuracy of CMR and SPECT to detect significant CAD in the female cohort (n = 281) was compared using McNemar's Chi-Squared Test and Leisenring’s Generalised Score Statistic. In a secondary analysis, receiver operating characteristic curves were generated for the stress perfusion CMR component and SPECT (using a summed stress scores for both).
CMR has significantly greater sensitivity, NPV and PPV compared to SPECT for the detection of CAD in women, but similar specificity. These findings in combination with an absence of ionising radiation exposure mean that CMR should be considered the preferred non-invasive imaging test for females with suspected CAD.<p>
CE-MARC was funded by a British Heart Foundation Programme Grant (RG/05/004).
- Greenwood JP: CE-MARC, et al: A Prospective Evaluation of Cardiovascular Magnetic Resonance and Single-Photon Emission Computed Tomography in Coronary Heart Disease. The Lancet. 2011,Google Scholar
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.